基于毒邪和玄府理论探析急性缺血性中风早期神经功能恶化的中医病机

TCM pathogenesis of early neurological deterioration in acute ischemic stroke based on the theory of toxin and Xuanfu

急性缺血性中风的高致残率、高死亡率给人类和社会带来了巨大负担,早期神经功能恶化作为引起急性缺血性中风不良预后的重要因素,是目前西医学的研究热点之一。中医学对于早期神经功能恶化早有认识,但缺乏系统的理论阐释。毒损脑络学说和玄府开合不利学说是中风病病机的重要理论基础,亦能为急性缺血性中风早期神经功能恶化的发生发展提供理论支撑。毒邪由于其依附性、酷烈性、秽浊性、从化性的特点,能够在风、火、痰、瘀、虚等邪气基础上化生,并败坏形体,影响玄府功能;玄府是人体最小的气血运行门户且分布广泛,在毒邪的作用下,玄府的开合功能受到严重影响,并常涉及多个脏腑,从而导致急性缺血性中风急性期的病情恶化。早期神经功能恶化的中医理论阐释有助于进一步提高中医药对于急性缺血性中风的治疗水平,使中医药更好地发挥既病防变及促进康复的重要作用。

The high disability and mortality rates of acute ischemic stroke have brought great burden to human beings and society.As an important factor causing adverse prognosis,early neurological deterioration has become one of research hotspots in modern medicine.Traditional Chinese medicine(TCM)has long recognized the deterioration of early neurological function,but there is still a lack of systematic theoretical explanation.As important theories of stroke pathogenesis,the theories of"toxin damaging the brain collateral"and"failure open and close of Xuanfu"can also provide theoretical support for the occurrence and development of early neurological deterioration in acute ischemic stroke.Because of its attachment,fierceness,turbidity,transforming and other characteristics,toxin can derive from wind,fire,phlegm,blood stasis and deficiency,and damage the body,which has a wide impact on the function of Xuanfu.As the smallest portal of the circulation of qi and blood in the human body,Xuanfu is widely distributed.Under the influence of toxin,the opening and closing function of Xuanfu and other viscera’s functions will be seriously affected,causing the deterioration of acute ischemic stroke in acute stage.The explanation based on TCM theory of early neurological deterioration is helpful to further improve the treatment of acute ischemic stroke with TCM,and to better play the important role of TCM in disease prevention and rehabilitation.